Women and Alcohol: Health Risks and the Path to Recovery – Mpls.St.Paul Magazine

From festive cocktail bars to wine-filled advent calendars, the holiday season often arrives with a celebratory clink. Between Thanksgiving and New Year’s alone, Americans increase their alcohol consumption by up to 40 percent. But for many women, that seasonal spike reveals a more complicated, year-round reality: Rates of substance use disorders are rising, according to SAMHSA.

For decades, addiction research and treatment have been built around a male-centric model, leaving women’s experiences and risks largely overlooked and underaddressed. Now, clinicians at M Health Fairview are working to close this gap, challenging decades of assumptions about alcohol and revealing a story medicine has only begun to tell.

The “Telescoping Effect” in AUDs

The gender gap in alcohol use disorders (AUDs) is quickly closing. According to data from the National Institute on Alcohol Abuse and Alcoholism, what was once a predominantly male issue is now affecting women at unprecedented rates.

An important nuance often overlooked in conversations about AUDs is that they emerge and progress differently in women. It’s a pattern that Dr. Katharine Parker, a family physician and addiction medicine specialist at M Health Fairview, sees often in her work. “The ‘telescoping effect,’” she explains, “describes a pattern we consistently see in studies, showing that while women often begin drinking later in life, their progression to heavy drinking and AUDs typically happens more quickly than in men.”

Experts believe the telescoping effect stems from a mix of social, cultural, and physiological factors, with women’s unique metabolism contributing significantly. Women process alcohol differently, making its effects stronger and the risks of dependence hasten.

“Metabolically speaking, women typically have a higher body fat percentage and less total body water than men.” Because alcohol is water-soluble, not fat-soluble, it has less space to distribute in women’s bodies. “That’s why alcohol concentrations rise faster in women and blood alcohol levels are higher after the same number of drinks,” she explains.

Women also have lower levels of gastric alcohol dehydrogenase, the enzyme that breaks down alcohol before it enters the bloodstream. “That difference contributes to higher blood alcohol levels and can accelerate the development of alcohol-related problems,” says Parker. 

Then there are the hormonal changes during menstruation and menopause that influence how alcohol affects the body. “With menopause specifically, alcohol can worsen vasomotor symptoms like hot flashes, intensify sleep disruptions, and contribute to bone density loss,” she says. “Heavy alcohol use early in life can also increase the risk of osteoporosis later on.”

Parker also cites generational and social factors at work: “I think the pandemic played a big role in increased alcohol use for many in the baby boomer generation. A lot of people retired straight into isolation, which created a recipe for higher consumption.”

Ultimately, alcohol’s impact crosses age and gender. “A lot of women express a deep sense of shame, saying, ‘I should know better,’” she says. “I always remind people, ‘You’re not alone. No one is immune, whether you’re 20 or 60. There’s a lot we can do to help.’”

Addressing stigma begins by rethinking how we talk about SUDs. “With substance use disorders, I like to compare them to diabetes or high blood pressure,” she says. “Just like we use medications, lifestyle changes, and environmental adjustments to manage those conditions, we can do the same for SUDs. These are chronic medical conditions, and there will be times when they’re easier to manage and times when they’re more challenging.”

As with any chronic condition, ongoing care and support are key to sustainable recovery. Parker tells her patients, “I want to see you on your good days and your bad days.… That’s how I can help you best.”

“With menopause specifically, alcohol can worsen vasomotor symptoms like hot flashes, intensify sleep disruptions, and contribute to bone density loss.”

 —Dr. Katharine Parker

Open Conversation

Conversations about alcohol often begin with curiosity, not confession. According to Dr. Kim DeRoche, neutral, open-ended questions can make it easier to open up—and easier for providers to help.

Examples of neutral framing:

• “I’ve been hearing more about how alcohol affects sleep. What’s the current thinking on that?”
• “There’s a lot of talk about alcohol and hormones lately; what does the research say?”
• “Is it normal to feel alcohol’s effects more as you get older?”

Primary Care, a First Line of Support for AUDs

For many, the first discussion about substance use doesn’t happen in rehab or therapy—it starts in a primary care setting. Dr. Kimberly DeRoche, family medicine physician and chief of primary care for M Health Fairview, says that all routine preventive exams include screenings for alcohol and substance use. The goal isn’t to make an immediate diagnosis but to open honest conversations. “We’re not just looking at how much someone is drinking,” she says. “Of course that matters, but the feelings around it are just as important. Guilt, worry, or concern from others can be warning signs that alcohol is affecting daily life or relationships. The more transparent the conversation, the more I can help.”

Even without obvious signs of an AUD, common symptoms can signal an emerging issue or a greater impact on well-being. “When something feels off, whether it’s fatigue, insomnia, or mood changes, it’s always worth asking whether alcohol might be playing a role,” she says.

A key part of DeRoche’s work is helping patients understand which of their symptoms may be amplified or shaped by alcohol. “One of the easiest ways to get clarity is to pause drinking for a short period,” she explains. “If your energy, sleep, or mood improves, that can tell you a lot. And if it feels hard to stop, even briefly, that can also serve as important information.”

Developing awareness and noticing patterns are often the first steps toward meaningful change. “For many women, the way alcohol affects their bodies shifts throughout their lives,” says DeRoche. “Some feel its effects more intensely over time, others less, and many notice changes in how quickly those effects set in and how they feel afterward. Being in tune with how your body responds is really important.”

But none of this can happen without trust, something she emphasizes in her work. “Women need to feel safe and supported; that’s why finding a provider you trust is so important. When patients feel comfortable, they’re more likely to bring forward their real concerns.”

With so much information available online, DeRoche notes that it can be hard to know what applies to your own life. That’s why she encourages people to bring their questions to their providers. “That’s exactly what your health care provider is there for: to help you make sense of it all and offer support.”

For those hesitant to bring up substance use directly, there are low-pressure ways to begin. “A lot of women start indirectly,” she says. “They might say, ‘My friends and I were talking about…’ or ask what I’ve seen in other patients. That’s often their way of opening the door to the conversation. I’ll meet them there and make space for that.”

The next steps, she adds, are about working together to find the right kind of support, whether that involves primary care, addiction medicine, mental health services, or a combination of approaches. “There are many pathways to support and healing,” she says. “An open, honest conversation is often the most powerful first step.”

And even without a formal diagnosis, feeling uncertain about your drinking is reason enough to act. “What’s most important for people to know is that they don’t have to face it alone,” says DeRoche. “There are so many resources available now, and reaching out can mark the beginning of meaningful change.” Follow the series at mspmag.com/carechronicles.

Metabolizing the Difference

The science behind “holding your liquor” isn’t about tolerance—it’s biology, says Dr. Katharine Parker. Women metabolize alcohol differently, with less water to dilute it, fewer enzymes to break it down, and hormones that amplify its impact. The result is stronger, longer-lasting effects from smaller amounts. 

At M Health Fairview, wellness for women is well within reach. To learn more, visit mhealthfairview.org/womenshealth.